The process and utility of classification and regression tree methodology in nursing research

Aim: This paper presents a discussion of classification and regression tree analysis and its utility in nursing research. Background: Classification and regression tree analysis is an exploratory research method used to illustrate associations between variables not suited to traditional regression analysis. Complex interactions are demonstrated between covariates and variables of interest in inverted tree diagrams. Design: Discussion paper. Data sources: English language literature was sourced from eBooks, Medline Complete and CINAHL Plus databases, Google and Google Scholar, hard copy research texts and retrieved reference lists for terms including classification and regression tree* and derivatives and recursive partitioning from 1984-2013. Discussion: Classification and regression tree analysis is an important method used to identify previously unknown patterns amongst data. Whilst there are several reasons to embrace this method as a means of exploratory quantitative research, issues regarding quality of data as well as the usefulness and validity of the findings should be considered. Implications for Nursing Research: Classification and regression tree analysis is a valuable tool to guide nurses to reduce gaps in the application of evidence to practice. With the ever-expanding availability of data, it is important that nurses understand the utility and limitations of the research method. Conclusion: Classification and regression tree analysis is an easily interpreted method for modelling interactions between health-related variables that would otherwise remain obscured. Knowledge is presented graphically, providing insightful understanding of complex and hierarchical relationships in an accessible and useful way to nursing and other health professions

Effect of patient sex on triage for ischaemic heart disease and treatment onset times: a retrospective analysis of Australian emergency department data

AbstractTime between emergency department (ED) presentation and treatment onset is an important, but little-researched phase within the revascularization process for ischaemic heart disease (IHD).ObjectiveTo determine if sex influences triage score allocation and treatment onset for patients with IHD in the ED.MethodsRetrospective data for patients 18–85years presenting to EDs from 2005 to 2010 for acute myocardial infarction (AMI), unstable and stable angina, and chest pain were analysed collectively and separately for AMI.ResultsProportionately more men (61% of males) were triaged correctly for AMI than women (51.4% of females; P<0.001). Across all triage categories, average treatment time was faster for men than women with AMI (P<0.001). When incorrectly triaged for AMI, treatment time for men was faster than for women (P=0.04). When correctly triaged for AMI, there was no difference in mean treatment time between men and women (P=0.538).ConclusionsSubstantial undertriage of AMI occurred for both sexes, but was worse in women. Incorrect triage led to prolonged treatment times for AMI, with women’s treatment delays longer than men’s. When triaged correctly, both sexes were treated early for AMI, emphasising the need for all patients to be accurately triaged for this time-sensitive disease

Testing a Model of Patient Characteristics, Psychologic Status, and Cognitive Function as Predictors of Self-Care in Persons with Chronic Heart Failure

Objective Self-care is a key component in the management of chronic heart failure (CHF). Yet there are many barriers that interfere with a patient\u27s ability to undertake self-care. The primary aim of the study was to test a conceptual model of determinants of CHF self-care. Specifically, we hypothesized that cognitive function and depressive symptoms would predict CHF self-care. Methods Fifty consecutive patients hospitalized with CHF were assessed for self-care (Self-Care of Heart Failure Index), cognitive function (Mini Mental State Exam), and depressive symptoms (Cardiac Depression Scale) during their index hospital admission. Other factors thought to influence self-care were tested in the model: age, gender, social isolation, self-care confidence, and comorbid illnesses. Multiple regression was used to test the model and to identify significant individual determinants of self-care maintenance and management. Results The model of 7 variables explained 39% (F [7, 42] 3.80; P = .003) of the variance in self-care maintenance and 38% (F [7, 42] 3.73; P = .003) of the variance in self-care management. Only 2 variables contributed significantly to the variance in self-care maintenance: age (P \u3c .01) and moderate-to-severe comorbidity (P \u3c .05). Four variables contributed significantly to the variance in self-care management: gender (P \u3c .05), moderate-to-severe comorbidity (P \u3c .05), depression (P \u3c .05), and self-care confidence (P \u3c .01). When cognitive function was removed from the models, the model explained less of the variance in self-care maintenance (35%) (F [6, 43] 3.91; P = .003) and management (34%) (F [6, 43] 3.71; P = .005). Conclusion Although cognitive function added to the model in predicting both self-care maintenance and management, it was not a significant predictor of CHF self-care compared with other modifiable and nonmodifiable factors. Depression explained only self-care management

Assessment of an established dialysis nurse practitioner model of care using mixed methods research

Aims and Objectives: To assess a dialysis nurse practitioner ( NP ) model of care by examining satisfaction, quality of life ( QOL ) and clinical outcomes of haemodialysis patients and explore experiences of dialysis nurses. Design: Mixed methods. Methods: Database analyses of dialysis indices amongst a sample ( n = 45 ) of haemodialysis patients; a survey ( n = 27 ) examining patient experience, satisfaction and QOL; and in-depth interviews with a sample ( n = 10 ) of nurses. Results: Nurses commended the NP role, with five themes emerging: “managing and co-ordinating”, “streamlining and alleviating”, “developing capability”, “supporting innovation and quality” and “connecting rurally”. Patients’ average age was 66 years and 71% were male. Patients’ satisfaction with the care they received was rated 3.5/4 or higher across seven parameters and the average QOL score was 7.9/10. Conclusion: The NP model of care is effective in enhancing patient care within a collaborative framework. The challenge is to sustain, and enhance the model, through mentorship programs for potential candidates

Symptom Recognition in Elders with Heart Failure

Purpose: Aging is associated with losses in hearing and vision. The objective of this study was to assess whether aging also is associated with less ability to detect and interpret afferent physiological information. Design: A cross‐sectional mixed methods study was conducted with 29 persons with a confirmed diagnosis of chronic heart failure of at least 6 months duration. The sample was divided at the median to compare younger (\u3c73 years) versus older (≥73 years) patients in the ability to detect and interpret their heart failure symptoms. Methods: Shortness of breath was stimulated using a 6‐minute walk test (6MWT) and used to assess the ability of heart failure patients to detect shortness of breath using the Borg measure of perceived exertion compared with gold standard ratings of each person\u27s shortness of breath by trained registered nurse research assistants (inter‐rater congruence 0.91). Accuracy of ratings by older patients was compared with those of younger patients. In‐depth interviews were used to assess symptom interpretation ability. Findings: Integrated quantitative and qualitative data confirmed that older patients had more difficulty in detecting and interpreting shortness of breath than younger patients. Older patients were twice as likely as younger to report a different level of shortness of breath than that noted by the registered nurse research assistants immediately after the 6MWT. Conclusions: These results support our theory of an age‐related decline in the ability to attend to internal physical symptoms. This decline may be a cause of poor early symptom detection. Clinical Relevance: The results of this study suggest that there is a need to develop interventions that focus on the symptom experience to help patients—particularly older ones—in somatic awareness and symptom interpretation. It may be useful to explore patients’ statements about how they feel: “Compared to what? How do you feel today compared to yesterday?

E-cigarettes and smoking cessation: evidence from a systematic review and meta-analysis

BACKGROUND: E-cigarettes are currently being debated regarding their possible role in smoking cessation and as they are becoming increasingly popular, the research to date requires investigation. OBJECTIVES: To investigate whether the use of e-cigarettes is associated with smoking cessation or reduction, and whether there is any difference in efficacy of e-cigarettes with and without nicotine on smoking cessation. DATA SOURCES: A systematic review of articles with no limit on publication date was conducted by searching PubMed, Web of Knowledge and Scopus databases. METHODS: Published studies, those reported smoking abstinence or reduction in cigarette consumption after the use of e-cigarettes, were included. Studies were systematically reviewed, and meta-analyses were conducted using Mantel-Haenszel fixed-effect and random-effects models. Degree of heterogeneity among studies and quality of the selected studies were evaluated. RESULTS: Six studies were included involving 7,551 participants. Meta-analyses included 1,242 participants who had complete data on smoking cessation. Nicotine filled e-cigarettes were more effective for cessation than those without nicotine (pooled Risk Ratio 2.29, 95%CI 1.05-4.97). Amongst 1,242 smokers, 224 (18%) reported smoking cessation after using nicotine-enriched e-cigarettes for a minimum period of six months. Use of such e-cigarettes was positively associated with smoking cessation with a pooled Effect Size of 0.20 (95%CI 0.11-0.28). Use of e-cigarettes was also associated with a reduction in the number of cigarettes used. LIMITATIONS: Included studies were heterogeneous, due to different study designs and gender variation. Whilst we were able to comment on the efficacy of nicotine vs. non-nicotine e-cigarettes for smoking cessation, we were unable to comment on the efficacy of e-cigarettes vs. other interventions for cessation, given the lack of comparator groups in the studies included in this meta-analysis. CONCLUSIONS: Use of e-cigarettes is associated with smoking cessation and reduction. More randomised controlled trials are needed to assess effectiveness against other cessation methods

Making decisions: nursing practices in critical care

This article reports the types and complexity level of decisions made in everyday clinical practice by critical care nurses. It also reports factors that influence the complexity of those decisions. A combination of methods were chosen for the two phase study. In the first phase, 12 qualified critical care nurses documented decisions (over a 2 hour period) on a clinical decision recording form designed by the researcher. In the second phase, participants attended a semi-structured focus group.From the analysis, five types of decisions were identified; assessment, intervention, organisation, communication and education. In addition to these documented decisions, three factors that influenced decision complexity were identified from a thematic analysis of the transcribed interviews; communication, patient related and properties of the decision. Nurses reported that communication decisions were the most difficult to make. However, the concept of nurses knowing the patient reduced the level of decision complexity. It is suggested that this has important implications for decision making practices of nurses working in the area of critical care and potentially for patient outcomes.<br /

Perioperative managers: role stressors and strategies for coping

This qualitative study explored the role stressors experienced by perioperative nurse managers, and identified resources and strategies they used in order to cope with the multiple demands upon their role. Grounded Theory methodology was used to inform the inquiry through interviews with the participants and thematic analysis of the data. The perioperative nurse managers who participated in the study indicated that the major stressors they experienced were related to managing their staff. Stress was reduced through the use of hospital resources and peer support, referring to post management education and information obtained from attending conferences. In addition, they used team building strategies, balanced priorities and engaged in social activities. These findings will assist directors of nursing and other nursing leaders in formulating the direction of appropriate support and structure for the development perioperative nurse managers.<br /

Nurse academics meeting the challenges of scholarship and research

This research study explored nurse academics\u27 perceptions and experiences of scholarship and research. Interviews were carried out with 20 nurse academics in four Australian states. A grounded theory approach was used to explore issues they faced. The paper discusses how academics engaged in research and scholarship integrate it into their work practices. The participants spoke of problems encountered, such as the difficulty of gaining higher degrees whilst undertaking additional research. They indicated they felt under significant pressure to publish. The organisational structures that a small number of institutions put in place to facilitate the development of a scholarly research culture are illustrated.<br /